Shannon Mary Barham, RD
Individual provider Active NPI Registered Dietitian · Provo, UT
NPI 1295438562 · NPPES record last updated Mar 24, 2023
Key facts
- NPI
- 1295438562
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 13196645-4901 (UT)
- Practice address
- 270 N 1080 E
Provo, UT 84606-3518 - Phone
- (385) 539-2122
- NPI assigned
- Mar 24, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13196645-4901 | UT | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connor Barham, LMFT, PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 13196645-4901 | UT | Yes |
Addresses
Primary practice location
270 N 1080 E
Provo, UT 84606-3518
Mailing address
270 N 1080 E
Provo, UT 84606-3518
Phone (385) 539-2122
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.